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Stenotrophomonas Maltophilia Differential Diagnoses

  • Author: Burke A Cunha, MD; Chief Editor: Michael Stuart Bronze, MD  more...
 
Updated: Mar 18, 2016
 
 

Diagnostic Considerations

The main clinical problem presented by S maltophilia is failing to recognize its significance in the clinical context. The recovery of S maltophilia from respiratory secretions or from the urine of catheterized patients should be regarded as colonization until proven otherwise. S maltophilia is a common cause of catheter-associated bacteruria in hospitalized patients.

S maltophilia commonly colonizes the urine and is potentially pathogenic only in those with impaired host defenses, ie, patients with organ transplants, diabetes, systemic lupus erythematosus (SLE), alcoholic cirrhosis, multiple myeloma, and those on steroids.

S maltophilia recovered from blood cultures may have come from contaminated intravenous fluids or from a distant infected source, eg, secondary bacteremia from the urinary tract in a patient who recently underwent instrumentation during a genitourinary (GU) procedure.

S maltophilia recovered from a wound with a clear or a serosanguineous discharge is of no clinical significance. If recovered from a purulent wound, S maltophilia may be the cause of the patient's wound infection.

The most common cause of confusion regarding S maltophilia is assuming that its recovery from body sites implies a pathogenic role, eg, sacral decubitus ulcer/osteomyelitis (S maltophilia does not cause osteomyelitis).

S maltophilia is a rare cause of nosocomial pneumonia in patients who are ventilated and presumed to have nosocomial pneumonia because of fever, pulmonary infiltrates, and leukocytosis.[7] The recovery of S maltophilia from respiratory secretions almost always represents colonization rather than infection, and, unless proven otherwise, its presence should not be addressed therapeutically.

S maltophilia may cause community-acquired pneumonia (CAP) in individuals with alcoholic cirrhosis.

Table 1. Hospital-Acquired S maltophilia Infections (Open Table in a new window)

Infection Predisposing Factor
Catheter-associated bacteriuria Indwelling urinary catheters
Intravenous line infections Central intravenous catheters
Urosepsis Urinary tract instrumentation
Primary bacteremia Arterial monitoring devices
Pseudobacteremia Contamination of blood during collection/processing of blood cultures
 
 
Contributor Information and Disclosures
Author

Burke A Cunha, MD Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Charles S Levy, MD Associate Professor, Department of Medicine, Section of Infectious Disease, George Washington University School of Medicine

Charles S Levy, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, Medical Society of the District of Columbia

Disclosure: Nothing to disclose.

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Table 1. Hospital-Acquired S maltophilia Infections
Infection Predisposing Factor
Catheter-associated bacteriuria Indwelling urinary catheters
Intravenous line infections Central intravenous catheters
Urosepsis Urinary tract instrumentation
Primary bacteremia Arterial monitoring devices
Pseudobacteremia Contamination of blood during collection/processing of blood cultures
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